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Sinusitis in the critical care patient

A M Seiden1

  • 1Department of Otolaryngology, University of Cincinnati College of Medicine, OH 45267-0528.

New Horizons (Baltimore, Md.)
|May 1, 1993
PubMed
Summary

Paranasal sinus infections are an overlooked cause of sepsis in critical care patients, often presenting without typical symptoms. Early recognition and treatment are crucial, especially in intubated patients.

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Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Otolaryngology

Background:

  • Paranasal sinus infections are an underrecognized source of sepsis in critically ill patients.
  • Communication barriers in these patients prevent typical sinusitis symptoms like facial pain.
  • Sepsis can be the primary clinical presentation of occult sinusitis.

Purpose of the Study:

  • To highlight paranasal sinusitis as a potential cause of sepsis in critical care.
  • To emphasize the importance of considering sinusitis in patients with unexplained fever.
  • To outline diagnostic and therapeutic strategies for critical care sinusitis.

Main Methods:

  • Review of clinical presentations and predisposing factors for sinusitis in critical care.
  • Discussion of diagnostic modalities including radiologic imaging (plain radiographs, CT scans).
  • Emphasis on maxillary sinus lavage for diagnosis and culture.

Main Results:

  • Nasotracheal intubation is a significant risk factor for developing sinusitis in this population.
  • Infections are frequently polymicrobial, with a notable prevalence of Gram-negative organisms like Pseudomonas aeruginosa.
  • Radiologic studies often reveal sinus inflammation or fluid, aiding diagnosis.

Conclusions:

  • Clinicians must maintain a high index of suspicion for sinusitis in critical care patients with fever of unknown origin.
  • Management involves prompt removal of nasal tubes, appropriate antibiotics, and decongestants.
  • Surgical drainage may be required in some cases; avoiding nasotracheal intubation is recommended for immunocompromised or prolonged intubation (>7 days).

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